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Nimotuzumab and radiotherapy for treatment of newly diagnosed diffuse intrinsic pontine glioma (DIPG): a phase III clinical study

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Abstract

Background

Diffuse intrinsic pontine glioma (DIPG) is a devastating cancer of childhood and adolescence.

Methods

The study included patients between 3 and 20 years with clinically and radiologically confirmed DIPG. Primary endpoint was 6-month progression-free survival (PFS) following administration of nimotuzumab in combination with external beam radiotherapy (RT). Nimotuzumab was administered intravenously at 150 mg/m2 weekly for 12 weeks. Radiotherapy at total dose of 54 Gy was delivered between week 3 and week 9. Response was evaluated based on clinical features and MRI findings according to RECIST criteria at week 12. Thereafter, patients continued to receive nimotuzumab every alternate week until disease progression/unmanageable toxicity. Adverse events (AE) were evaluated according to Common Terminology Criteria for Adverse Events (CTC-AE) Version 3.0 (CTC-AE3).

Results

All 42 patients received at least one dose of nimotuzumab in outpatient settings. Two patients had partial response (4.8%), 27 had stable disease (64.3%), 10 had progressive disease (23.8%) and 3 patients (7.1%) could not be evaluated. The objective response rate (ORR) was 4.8%. Median PFS was 5.8 months and median overall survival (OS) was 9.4 months. Most common drug-related AEs were alopecia (14.3%), vomiting, headache and radiation skin injury (7.1% each). Therapy-related serious adverse events (SAEs) were intra-tumoral bleeding and acute respiratory failure, which were difficult to distinguish from effects of tumor progression.

Conclusions

Concomitant treatment with RT and nimotuzumab was feasible in an outpatient setting. The PFS and OS were comparable to results achieved with RT and intensive chemotherapy in hospitalized setting.

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Acknowledgements

Authors are thankful to all patients and their families who were a part of the study. We would also like to thank all pediatricians, medical doctors, neurologists, medical oncologists and nurses who participated and without whose contribution this study would not have been possible.

Funding

This study was funded by Oncoscience GmbH, Schenefeld, Germany (Study No.: OSAG 101-BSC-05). Oncoscience GmbH has also provided the investigational drug nimotuzumab.

Author information

Author notes

  1. G. Fleischhack and M. Massimino contributed equally to the manuscript.

Authors and Affiliations

  1. Paediatric Haematology and Oncology, Paediatrics III, University Hospital of Essen, 45122, Essen, Germany

    G. Fleischhack

  2. Department of Paediatric Haematology/Oncology, Children Medical Hospital, University of Bonn, 53113, Bonn, Germany

    G. Fleischhack & U. Bode

  3. Paediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milano, Italy

    M. Massimino & V. Biassoni

  4. Department of Neuroradiology, University of Wuerzburg, 97080, Würzburg, Germany

    M. Warmuth-Metz

  5. Paediatric Neurosurgical Department, Burdenko Neurosurgical Institute, Moscow, 125047, Russia

    E. Khuhlaeva & S. K. Gorelishev

  6. Department of Paediatric Haematology/Oncology, Children’s Medical Hospital, University of Duesseldorf, 40225, Düsseldorf, Germany

    G. Janssen & C. Kramm

  7. Department of Paediatric Haematology/Oncology, Saarland University, 66421, Homburg/Saar, Germany

    N. Graf & H. Reinhard

  8. Department of Paediatric Hematology/Oncology, University of Wuerzburg, University Children’s Hospital, 97080, Wuerzburg, Germany

    S. Rutkowski & P. G. Schlegel

  9. Department of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany

    S. Rutkowski

  10. Department of Paediatric Haematology/Oncology, Medical School, Children’s Medical Hospital, 30625, Hannover, Germany

    A. Beilken

  11. Department of Paediatric Haematology/Oncology, Children’s Medical Hospital, University of Munich, 80337, Munich, Germany

    I. Schmid

  12. Division of Paediatric Haematology and Oncology, Department of Child and Adolescent Health, University Medical Center Göttingen, 37075, Göttingen, Germany

    C. Kramm

  13. Paediatric Haematology and Oncology, Asklepios Hospital, 53757, Sankt Augustin, Germany

    H. Reinhard

  14. Department of RT and Radiooncology, University of Leipzig, 04103, Leipzig, Germany

    R.-D. Kortmann

  15. Oncoscience GmbH, 22869, Schenefeld, Germany

    D. Reuter & F. Bach

  16. Center of Molecular Immunology, Havana, Cuba

    N. E. Iznaga-Escobar

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  1. G. Fleischhack
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  2. M. Massimino
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  4. E. Khuhlaeva
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Corresponding author

Correspondence to G. Fleischhack.

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Conflicts of interest

GF, MM, MWM, EK, GJ, NG, SR, AB, IS, VB, SKG, CK, HR, PGS, RDK and UB have received research funding and expense allowance for study conduct from Oncoscience GmbH. GF and UB have received support from Oncoscience GmbH for meeting travel to present study results. NEIE is an employee of the Center of Molecular Immunology, the research institution that patented and manufactures nimotuzumab. DR is an employee of Oncoscience GmbH. FB was an employee and has had stock options of Oncoscience GmbH that funded this study and has provided the investigational drug.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national committees. The trial was conducted in accordance with 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The institutional review boards or ethics committees of all participating centers reviewed and approved the protocol. All parents/guardians and patients, where appropriate, gave their written informed consent.

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F. Bach—deceased.

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Fleischhack, G., Massimino, M., Warmuth-Metz, M. et al. Nimotuzumab and radiotherapy for treatment of newly diagnosed diffuse intrinsic pontine glioma (DIPG): a phase III clinical study. J Neurooncol 143, 107–113 (2019). https://doi.org/10.1007/s11060-019-03140-z

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